Ongoing Conflicts and the Devastating Impact on Mental Health in Yemen

Hebah Mohammed – Sawt Al-Amal (Voice of Hope)

In the heart of Yemen, horrific conflicts rage, leaving behind devastating consequences that cannot be ignored. But have we ever considered the hidden scars of these conflicts? Have we pondered their deadly impact on the mental health of individuals?!

Conflicts continue to cause material destruction and human casualties, but mental health is a completely different story. The bloody conflicts in Yemen have left deep wounds in the souls, wounds that are difficult to heal and can persist for years after the conflicts end.

Anxiety, depression, trauma, and other mental disorders have become commonplace among Yemenis. They live in a state of constant insecurity, exposed to danger and threats. Families suffer the loss of loved ones and displacement, while children are exposed to unimaginable trauma due to the violence and destruction around them.

The detrimental psychological effects of the conflicts in Yemen extend far beyond physical suffering.  The conflicts erode self-confidence, damage personal relationships, and impair the ability to express emotions and cope with daily challenges. These silent struggles invade minds and seep into souls, leading to a deterioration in the mental health of individuals and exacerbating pre-existing mental illnesses.

Mental Health Services Before the Conflict

According to a 2017 study by Sana’a Center for Strategic Studies, titled “The Impact of War on Mental Health in Yemen: A Neglected Crisis”, there used to be limited and undocumented information available on mental health services in Yemen before the conflict. However, available data indicates a shortage of relevant institutions and poor quality of services provided. According to the 2010 National Health Strategy, there are only 44 psychiatrists in Yemen out of 8,500 doctors.

World Health Organization (WHO) statistics from 2011 indicate that there are 4 mental health hospitals in Yemen, with 0.21 psychiatrists and 0.17 psychologists per 100,000 people. In contrast, there are 12.40 psychiatrists and 29.03 psychologists per 100,000 people in the United States, and 29.68 psychiatrists and 54.28 psychologists per 100,000 people in Norway.  The latest WHO data from 2014 on the number of mental health professionals in Yemen was not included.

The National Mental Health Strategy in Yemen indicated the existence of 19 mental health facilities in the country, including hospitals, clinics, and health facilities within prisons. However, there appears to be a discrepancy between this data and that of the World Health Organization, further highlighting the difficulty in obtaining reliable information about mental health services in Yemen before the conflict.

The study also added that it is difficult to find detailed publications on the role of traditional healers, Shaikhs, and others in providing mental healthcare and social support to the population in Yemen before the conflict. Traditional and Quranic healers primarily provided care to individuals experiencing mental health disorders, and people usually resorted to formal mental health treatment in severe cases such as schizophrenia and psychosis.

Mental health professional Dr. Fadhila Al-Shuaibi also pointed out that, even before the outbreak of the conflict in Yemen, numerous factors affected the quality of available care. The quality of services ranged from limited facilities to a shortage of qualified professionals. People in Yemen face many difficulties accessing specialized care, especially vulnerable groups such as women, children, adolescents, the elderly, and those with chronic conditions or addiction.

She adds, “Primary healthcare in Yemen lacks the integration of mental health as an essential component, meaning many people struggle to access appropriate treatment when first interacting with the health system. Despite the existence of a formal protocol established in 2009 to standardize the diagnosis, assessment, and treatment of mental health by professors of psychiatry in universities, its implementation suffers from shortcomings in many cases. Additionally, the cost of medication remains high for the majority of the population, and electroconvulsive therapy is still widely used.”

The Impact of Conflict on Mental Health

Yemen is currently enduring an era of bloody and ongoing conflict. The impact of this protracted conflict on the mental health of its population cannot be underestimated. Since the outset of the conflict, Yemen has faced immense challenges in the field of mental health, and the crisis has escalated day by day. This necessitates attention to this critical issue and its devastating impact on the Yemeni people.

Dr. Ali Rajih, a psychological consultant and Head of the Training and Research Unit at the Psychological Counseling Center, at Ibb University, states, “Between the pre-conflict period and the present, there were attempts to increase attention to mental health. However, the conflict arrived and exacerbated the situation, increasing the need for more specialized hospitals and centers, as well as specialized personnel. Despite this dire need, progress has not been made to meet these requirements.”

According to a 2020-2021 report by the Ministry of Health in Sana’a, there are only 59 psychiatrists in Yemen today, a ratio of one doctor for every 505,084 people. The number of hospital beds in Yemen does not exceed 990, a rate of 3 beds per 100,000 people.  The report also highlights a severe shortage of supplies and medications for psychological and mental disorders, as well as a lack of mental health professionals.

A study conducted by Family Development and Counseling Foundation between March 2015 and June 2017 indicated that the prevalence of mental disorders among Yemenis affected by the conflict increased by approximately 19.5%, reaching a rate of 195 cases per 1,000 people. This has catastrophic short-term and long-term consequences.

According to Dr. Rajih, the total burden of mental disorders, measured in disability-adjusted life years (DALYs), is 7.4%. The disability rate resulting from mental disorders reaches 22%, one of the highest disability rates related to mental illness. This situation portends a humanitarian catastrophe.

He adds, “The national economy also bears a heavy burden from the costs of addressing the direct and indirect psychological effects on nearly 5 million people suffering psychologically, according to the aforementioned study.”

He continues, “We cannot ignore a critical issue like mental health in a country like Yemen, which has been witnessing ongoing conflicts for several years and suffers from a clear shortage of health services. Looking at the available statistics, it is evident that the attention given to mental health by relevant authorities does not align with the magnitude of the challenges facing the country due to the ongoing conflicts. This disparity makes the situation increasingly perilous.”

Dr. Rajih explains that despite the efforts made by relevant organizations and institutions, they are still far from meeting the actual needs. In 2022, the World Health Organization collaborated with the Ministry of Public Health and Population to develop the first national mental health strategy since 2010, aiming to provide a comprehensive and accessible mental healthcare system in Yemen.

According to a 2024 report by the World Health Organization’s Media Center, the estimated number of individuals suffering from psychological trauma and stress resulting from the ongoing conflict in Yemen is around 7 million, approximately a quarter of the country’s population. Despite their urgent need for mental health support, only 120,000 individuals have consistent access to services.

Mental Health Challenges in Yemen

Ongoing conflicts and disputes, destruction of infrastructure, rampant poverty, and lack of income sources have led to a deterioration in mental health and an increase in cases of anxiety and depression, driving some individuals to suicide. Many observers attribute the factors contributing to the decline in citizens’ mental health to several reasons, including poverty and low income.

According to several studies on mental health in Yemen, including one by Sana’a Center for Strategic Studies in 2017, repeated exposure to violence, lack of security, food insecurity, poverty, and ultimately the breakdown of social bonds, all constitute enormous pressures on Yemenis and exacerbate the deterioration of their mental health. The report “Assessing the Impact of War on Development in Yemen” by United Nations Development Program (UNDP) in 2020 indicates that 45% of the population has lost their primary sources of income due to the conflict, contributing to the decline in mental health.

Furthermore, displacement and social stigma are among the most significant factors resulting from the conflict. Due to material losses estimated at $181 billion, according to a February 2021 OCHA report, the number of internally displaced persons (IDPs) has reached 4 million. This has led to various psychological crises.

Halima Asa’ad, a mental health professional, states based on her work in IDP camps across several governorates that many patients refuse to go to mental health centers due to social stigma and fear of societal reactions, as those seeking mental health treatment are often labeled “crazy.”

Psychotherapist Dr. Mursila Al-Awadhi concurs, saying, “In light of the conflict in Yemen, it is evident that the mental health of the population is suffering from widespread negative impacts. Despite the lack of comprehensive data, current information indicates that many individuals are experiencing psychological, social, and emotional challenges.”

Al-Shuaibi mentions that a study conducted by Epos for Consulting and Health Services, supported by the European Union Commission and in partnership with the Ministry of Health and Population, indicated that 42% of Yemen’s population in 2019 suffered from various mental disorders, including depression at 27%, anxiety at 25%, schizophrenia at 18%, and phobias at 4%.